D. Dalela
Dr. D. Dalela
Transurethral Resection
Transurethral Resection
URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW
of Prostate
(TURP)(TURP)
First Edition-2010
Composing & DesigningMr. Sanjay KumarSmt. Urmila Shukla
ArtMr. Jai Prakash
Mr. Ankit Mehrotra??Publishers
Triveni Educational PublishersLucknow
PrinterMaruti Scanners, LucknowMob. : 9839055651
Uro-Health Reserch Center
2/503, Vikas Nagar, Lucknow
Tel. : 0522-2768899, 2768850
Email : [email protected]
Dr. Divakar Dalela
c
Book Cost Rs. 275/-
URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW
??MBBS, MS (Surgery),Mch, (Urology), FICS (Urology), FAMS (Urology),
Dr. D. Dalela
Dept. of Urology, CSM Medical University(Erstwhile KG Medical College)
Lucknow
Professor & Former Head
Transurethral Resection
Transurethral Resection
of Prostate
(TURP)(TURP)A patient,s guide book
This book on TURP is an outcome of combined and
persistent effort of many people. First of all, my patients who posed
these questions, were shown the manuscript of ' answers'. Their
valuable suggestions added simplicity & clarity to answers. My
father Dr. R C Dalela, who him self is a renowned author and editor
of leading internal journal, continuously encouraged me to do
writing work. My all M. Ch. students, departmental colleagues have
been source of information and inspiration my wife Dr. Abha, son
Deepansh and daughter Disha looked at the manuscript at various
stages, Mr. Jai Prakash & Mr. Ankit Malhotra made
i l lustrat ions, Mr. Sanjay kumar and Mrs.
Urmila Shukla composed & designed the book
and Mr. Sunil Baijal brought the book is present
shape by printing it . All my book is appreciated by
the patients and professional colleagues ,
the credit should go to all these people.
- Dr. D. Dalela
CKNOWLEDGEMENTSCKNOWLEDGEMENTSAA
What is the need for this book?What is the need for this book? ??
URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW
??Respected Sir,
You have been suffering from the prostatic
problems for long and now you have decided to
undergo the operation for the same.
This book is aimed to satisfy all your queries
regarding the operation, your postoperative period in
the hospital and life after operation. To make this book
universally appealing, a number of problems and side
effects have been mentioned here–but it does not
mean that you are going to have all these problems.
These are just written with the intention that in case
you develop any of them, you will know beforehand
how simply are they handled thus minimizing your
anxiety.
We are committed to give the best results of
your operation and hope that, our effort of imparting
you all the knowledge regarding your operation will
benefit you in overcoming all your doubts and help in
speedy recovery.
With regards
Divakar Dalela
CONTENTSCONTENTS
1.General information about prostate.
2.What is T.U.R.P.?
3.What precautions you need to take before operation?
4.What may happen to you after the operation?
Some RoutinesSome Routines
a. Starting meals and drinks.
b. Postoperative position in bed.
c. Postoperative administration of intravenous fluid by nurse.
d. Defecation after operation.
e. New problems after defecation.
f. Getting ambulatory after operation–Resuming walking
and sitting.
Some deviationsSome deviations
a. Avoiding blockage of urethral catheter by blood clots.
b. Shivering after operation.
c. Small amount of blood in catheter and Uro-bag.
d. Small amount of blood from sides of catheter or penis.
e. Sudden blockage of catheter.
f. Sudden colicky pain in radiating to tip of penis lower abdomen.
g. Slight mucus discharge from sides of catheter.
h. Postoperative cough or problems with breathing.
a. When to contact your doctor?
b. Some important points.
When will your catheter be removed?
What will happen after catheter removal?
5.What precautions will you take at home after discharge
from hospital?
CONTENTS
CONTENTS
*********
Prostate is a small walnut-shaped gland which is an important part of the
male genital system. It is situated below the urinary bladder and surrounds the
urethra. It makes an important ingredient for the semen which helps in sperms
motility and vitality.
The prostate gland increases in size in men above 50 years of age. It is in
fact a part of aging process just like you get cataract in your eyes or you
develop graying of hair. Due to the increase in size of the gland or inflammation
of gland the urethra is compressed leading to obstruction in urinary flow.
Previously the prostate gland was removed by a big and complicated open
surgery, but now with the help of modern techniques the prostate can be
removed endoscopically without any incision or open surgery.
01
General information about prostateGeneral information about prostate
Urinary bladder
Normal Prostate
Urethra
Enlarged Prostate
This operation is performed mostly by giving spinal anesthesia into the
lower back that makes the lower body numb. In this technique an endoscope is
passed into the bladder via the urethra. The enlarged prostate gland is
visualized in magnification on the video monitor using the lens and the camera
system.
02
What is TURP technique?What is TURP technique?
The enlarged part of the gland is sliced into small pieces by the help of a
small electrical instrument. These sliced chips are then evacuated from
bladder using a special device. In this technique (TURP), no suture or incision
is given. The internal bleeding is stopped using the endoscopy cauterization.
Thus patient feels minimal discomfort during and after the operation. The
majority of the enlarged gland is removed using this technique and mostly the
patients don't feel any sort of problems after that.
After operation a siliconized catheter is
placed into the urinary passage for three to four
days. This catheter helps in evacuating the urine
thereby giving time for healing of the internal
wound. After removal of catheter you can pass
urine freely with full force without any obstruction
or problem.
The biggest evidence of the unprecedented
success of this technique is that almost 90%
operations worldwide for benign prostatic
hyperplasia are done using this technique only.
03
Removal of prostate tissue in small chips
04
What precautions to take before the operation?What precautions to take before the operation?
The endoscopic surgery for the removal of the prostate is a highly
specialized surgical technique. There are certain points which are important
for the preparation of this surgery.
1. If you are taking any anticoagulant
medications such as aspirin etc, then please tell
it to your doctor. You may have to stop these
medications at least 5-6 days prior to surgery.
2. If you had any urinary infection in the past and
have been advised to take antibiotics, please do
continue to take these medications as per your
doctor's advice.
3. If you are suffering from constipation, then do
ask about its remedy from your doctor. As you may
not strain for defecation after this operation, you
have to get your constipation managed prior to
surgery.
4. If you experience bouts of cough along with
sputum please take proper treatment for it. Taking
proper medications and steam inhalation may
prevent you from many problems after surgery.
5. If you are habitual to smoking Bidi or
cigarette, leaving the habit will certainly benefit
you.
05
5. If you are taking any anti-hypertensive
medications then please do tell your doctor. If
you are on a salt or sodium-restricted diet too, tell
your doctor as low sodium levels during operation
may lead to complications. It is advisable for you
to check your blood sodium levels before surgery.
6. If your prostate gland is too big (i.e. more than
70cc), your doctor may advise you to arrange one
to two units of blood beforehand. This is
absolutely essential for your wellbeing during the
surgery.
7. If you are allergic to any drug, do tell your
doctor at the earliest.
8. If you are suffering from Diabetes, Asthma or
have suffered from any disease like epilepsy, or
jaundice in the past or if you had undergone any
sort of operation in the past, do tell your doctor
about the same. If you have experienced any
problem during or after that surgery inform your
doctor about that and also show your previous
records of the same.
After your operation till the time of your stay at hospital (approximately 2-3
days), you may experience some small problems that may worry you. All these
problems are very small and are either self-resolving or can be effectively and
easily managed by your doctor and nursing staff. Some of the problems are
discussed below :
06
How will you recover after the operation?How will you recover after the operation?
Some RoutinesSome Routines
If everything remains normal, you can be
allowed by your doctor to have water along with
few biscuits just 3-4 hours after the surgery.
Later on the day of surgery, you can take light
meals which you can digest easily while lying
down like vegetable soups, fruit juices, porridge
etc.
Starting meals and drinks
You have to lie down straight in bed for 10-12 hours after the operation.
Sometimes the doctor may even advise you not
use pillow for sometime. This is done to prevent
problems like excessive headache from the
spinal anesthesia. Sometimes you may also be
advised to keep a pillow under your legs; this is
done to maintain your blood pressure. Adhering
to the instructions will result in speedy recovery
and prevent complications.
Postoperative position in bed
07
You will be administered intravenous fluids for 10-12 hours after the
operation. The type, quantity and strength of
fluids is decided by your doctor only after duly
considering your body weight, your other
diseases and your health. If you experience
some shivering during administration of the
fluid, the duty nurse may temporarily stop this
fluid but this is not going to harm your body.
Postoperative administration of intravenous fluid
If everything remains well, you will be allowed to get up and start walking
on the third day of surgery. It is advised to do bed rest after surgery but
absolute bed rest is not necessary. When you start walking then tell the duty
nurse to empty your Urobag and then
you start walking holding the Urobag
carefully in your hand. If you start
walking with a full bag, chances are
there that this bag may accidentally
fall and get entangled in your legs.
This may result in sudden traction and
impact on the operation site in the
prostate and may lead to bleeding.
Getting ambulatory after operation – Resuming walking and sitting
08
Sometimes you may feel slightly feverish along with mild shivering.
Don't get anxious, this can be easily managed
with a shot of injection Avil within 20-30 minutes.
This happens due to infusion of intravenous
glucose or the fluid used for catheter irrigation.
You may also experience mild redness in urine
during this period of shivering, but this resolves
spontaneously once shivering stops.
Shivering after operation
Sometimes after passing stools, you may notice some blood drops by
the sides of the catheter. Even the urine collected in the Urobag may also be
slightly red in colour. This get resolved spontaneously by increasing the
water intake and taking rest. If it is not resolving spontaneously tell your
doctor about it. This usually happens due to
straining during passing stools, so try to pass
stools without any straining. Wipe away the
blood droplets on the sides of catheter by
moist cotton. We recommend to apply
antibiotic cream on the tip of penis and
protect it by a gauze piece to avoid the soiling
of your clothes by these blood drops.
New problems after passing stools
09
Some deviationsSome deviations
Those patients who have some problem
with breathing or have chronic cough problems,
should consult the doctor about it, as strong
bouts of coughing may start some bleeding.
Proper treatment is necessary for this cough.
Postoperative cough or problems with breathing
As this operation is done endoscopically by
passing the endoscope through urethra, no
superficial wound is visible but there is a small
wound near the bladder neck. In order to hasten
the healing of the wound, a tri-way rubber
catheter is placed in your bladder. A special fluid
is passed into the bladder through this tube which
continuously washes the wound and thus
prevents formation of blood clots by continuous
dissolution of blood that is oozing through the
wound. This catheter is removed 3-4 days after
surgery.
Avoiding blockade of urethral catheter by blood clots
10
The urine collected in the Urobag via the
catheter is slightly pinkish in colour. This is
controlled through the special fluid drained into
the catheter, but sometimes the urine may
become dark red in colour with few clots in the
catheter. If so happens, contact your doctor
immediately. He can handle this situation quite
easily and efficiently, so you don't have to worry
about it.
Small amount of blood in catheter and Uro-bag
Sometimes the catheter may get blocked due to the blood clots or the
resected chips of the prostate. As per the figure given on page 3, your
bladder is continuously filled with the special
fluid and now that the outflow of that fluid has
been blocked, your bladder fills up with the
fluid and you may feel strong desire to urinate
along with pain in lower abdomen. If so
happens, contact the duty nurse immediately
as she knows how to handle the situation by
clearing up the catheter blockade. The
catheter is generally cleaned by pumping or
with the use of a big syringe.
Sudden blockade of catheter
11
Some men feel mild pain and burning in the lower abdomen or at the tip of
penis. There may be a strong feeling that urine is going to come from the
sides of catheter. Some men may even pass sufficient quantity of urine by the
catheter side of. This is due to the irritation of trigone by the balloon of the
catheter. During passing of the stools the
“Trigone” of the bladder, which is a highly
sensitive part of the bladder gets irritated by
the catheter balloon resulting in sudden and
strong desire to urinate. For the same reason
you feel pain at the tip of the penis. This
problems mostly gets resolved after
sometime but if continues for long time and
becomes troublesome, consult your doctor.
Sudden onset of colicky pain in lower abdomen radiating to tip of penis
You will be made to pass stools using an enema prior to surgery so it is
possible that you may not pass stools the next
day. So you don't get worried about it. The
doctor may advise you some medications for
stool softening and also to prevent straining
during passing stools. If you are taking stool
softeners and laxatives, or if you are habitual of
passing stools only with help of a specific drug,
then do tell your doctor about it.
Passing stools after operation
12
There might be some small quantity of blood oozing from the sides of the
catheter and may stain your clothes. This stops
spontaneously after one to two days.
Sometimes this blood may clot on the tip of the
penis and may give a feeling of tightness. To
prevent this, wipe away the blood droplets with
awet sterile gauze, apply an antibiotic cream
and wrap the tip of penis with the sterile gauze.
Small amount of blood escaping from sides of catheter or penis
Till the time you are on catheter, some amount of blood and mucous gets
discharged from the sides of catheter and
sticks to it. Please wipe this with the help of
moist cotton carefully and apply an
antibiotic cream over it. You will not feel any
sort of pain or tingling at the tip of penis after
that. If you have retracted the foreskin of
your penis while doing so, don't forget to pull
back the skin at its place.
Slight mucus discharge from sides of catheter
13
When will your catheter be removed and what may happen these after?When will your catheter be removed and what may happen these after?
Usually after three to four days of
operation, when the urine becomes
clear, your catheter will be removed. If
the bleeding continues for more days of
if the patient has fever postoperatively or
if the prostate size was very large or if
the post void urine before surgery was
more, 300ml then your catheter may be
kept for a longer period of time.
1. After removal of catheter you may
experience mild burning and pain during
start and end of urination.
2. You may also experience mild
bleeding in the urine particularly in the
start of urination.
3. There may be mild fever along with
shivering.
14
4. Some patients may experience
leakage of a few drops of urine after
urination which may wet their clothes.
5. Some patients may experience
increase in frequency of urination along
with mild burning. This is particularly
seen in those patients who have been on
catheter for a longer period of time.
6. Sometimes, you may find it difficult
to hold urine. The urine may start even
dribbling before you reach the toilet. The
patient may feel that he has decreased
control over his urine holding power.
7. You may pass a few small pieces of
flesh along with clotted blood through
your urinary passage. These are actually
the resected chips of the prostate.
8. Sometimes a big chip of prostate
may result in temporary obstruction in
urinary flow but when this passes out,
the urinary stream again becomes
normal.
These are dependent on
the patient's body, the size of the gland, urinary infection, the power of bladder
wall, and the duration of catheterization. All these problems get cured within
two to four days. Please be patient and continue all the medications follow
advice given by your doctor. Getting impatient and consulting elsewhere may
result in more complications. Please remember the doctor who has operated
you knows best about you and your disease and is determined to cure you as
early as possible.
All the above mentioned problems (1-9) are not necessarily going to
happen to every patient. Some may get one, while another person may get
another or may be some one doesn't get any of them.
00
9. Sometimes due to the inflammation at the operation
site, the patient may feel slight pain or may not be able to
urinate upon removal of the catheter. Please don't strain in
this situation as it may result in mild
blood in urination. Consult your
doctor about it. It is possible that you
may need catheter for a longer period
of time. As soon as your doctor
determines that the inflammation at
the site has regressed he will remove
the catheter and all patients get
healed eventually.
You should remain at home for few days taking all the necessary
precautions as advised. Do remember that you have a wound inside at the site
of operation of prostate. Normally all the external wounds on human body get
healed by 7-10 days but the wound that is made at prostate site may take 3-4
weeks for complete healing firstly because primarily there is a constant urinary
flow over the wound and secondly we can not apply any medicine or antibiotic
cream directly on the wound. So you have to take the following precautions
for about one month after the operation.
q i.e. at
least 4 Liters a day. You can
also have fruit juices, milk
and tea also. This will result
i n i n c r e a s e d u r i n e
production and when you
pass urine frequently, the
prostatic wound will be
washed clear of infection
and will heal faster.
Drink lots of water
15
What precautions should you take at home after discharge from hospital?What precautions should you take at home after discharge from hospital?
Healing area at the site
of prostate surgery
q as they will
increase your constipation.
q Take medicines as
prescribed by your doctor for it. Don't strain too
much while passing stools as this may result in
appearance of some blood in urine.
q It you are suffering from
constant cough, consult your doctor about it and
get it treated. Coughing and sneezing too hard
may result in undue pressure at the operation
site of prostate and may result in mild blood in
urine.
q such as on tractor, bullock carts, or horse rides and also
avoid long rides on bus, cars etc for 15-20 days after operation. Trains
may be a better option for travel.
q
such as climbing stairs
rapidly, lifting heavy objec-
ts etc., but you can do your
normal daily activities.
Don't take much of oily and spicy food
Try to avoid constipation.
Don't cough too hard.
Avoid jerky rides
Avoid strenuous activities
16
q You have to abstain from any sexual activity for
at least 4-6 weeks after surgery. This may result
in pain and there might be no ejaculation at all.
Once you resume your sexual activity you may
experience a peculiar feeling of 'dry ejaculation'
i.e. You will feel that ejaculation has taken place
but semen does not come out. In fact, it goes
inside the urinary bladder and you may notice
the same in your urine later on. Though, this is
little peculiar, but it is completely harmless. In
some patients it improves with passage of time
while in some it may persist. Some patients also
experience decrease is their erection but if you
do not have other systemic factors like diabetes
etc, this also improve in due course of time.
q Don't forget to take your medications as advised
by your doctor and also don't try to change any
medication on your own.
17
Seminal vesicle
Sanjay K
umar
n If you are experiencing constant blood and clots in your urine.
n If you are having high grade fever along with chills and shivering.
n If you are having increased
burning and pain in urination or
you have increased frequency of
urination.
n I f you a re fee l ing more
obstruction in urination and
having pain and swelling in lower
abdomen.
n If your urinary stream becomes thin in future. This may possibly be due to
some constriction in your urethra. This problem can be cured fully if
diagnosed and treated at the right time.
n All the chips of the prostate which are taken out are sent to the pathology
lab for histopathological evaluation. Please don't forget to take the report
from the lab and show it to your doctor.
n Few patients (only 1-2%) may continue to suffer
from some urinary problems due to weakness in
urinary bladder muscles or due to some unknown
reasons. With proper investigations and due
course of medications, these patients also get
cured in time.
n Only one percent patients who have completely
lost their power to control urine may take four to
six months for complete recovery.
18
When to contact your doctor?
Some important Points
Prof. D. Dalela is an internationally renowned Urologist,
committed to spreading the Urological knowledge not only amidst
medical students but also amongst the nursing community,
practitioners of alternative medicine, paramedical personals and
patients.
He joined K.G. Medical College Lucknow as medical graduate in
1979. He completed his MBBS with lot of hard work and gathered 6 silver medals, 18 Gold
medals including. The prestigious Hewett gold medal in the year 1983 for being the topper
of his batch. He completed his M.S. (Surgery) from K.G. Medical College in year 1987-88
and then proceeded to Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow to obtain M.Ch. Urology degree in 1991-92. Ever since, he has been working as
a faculty member of K.G. Medical University and is credited with establishing a fully
equipped Dept. of Urology during his Headship. His penchant for research is equally
strong. He has published over 110 research papers, innovated 14 specialised urological
operating techniques, innovated three urological instruments and developed many
urological softwares. Through his 'Uro-Health Education Cell' he has written 15 patient
education pamphlates in English, 15 in Hindi, five operation guide book both in Hindi &
English and five urology disease books in both languages and the Hindi version of his book
on catheter has been awarded Third Prize by ICMR in 2008 as the “Best Popular Medical
Book.” He has travelled to over ten countries to present his research work in various
conferences and has been Operating Faculty in many live operating workshops. He has
been awarded FAMS in urology by seational Academy of Medical Science in 2009.
Dr. Dalela is very popular amongst his students as a teacher in urology, and by his
efforts, his department is already a frontrunner for its contributions in national and
international urology.
Dr. Divakar DalelaFormer Head, Department of Urology, CSM Medical University
Erstwhile King George Medical CollegeLucknow
URO-HEALTH EDUCATION CELLURO-HEALTH RESEARCH CENTER, LUCKNOW
Normal Prostate Enlarged Prostate